Camp 220 Student Registration 2023
Camp 220 Student Summer Camp
July 17-21, 2023
$375/student- $100 non-refundable deposit
Completed 6th to 12th (as of summer 2023)
Student Info
Name
*
Student Phone
*
Gender
*
Please select one option.
Female
Male
DOB
*
Completed Grade (as of summer 2023)
*
Please select one option.
6th
7th
8th
9th
10th
11th
12th
T-shirt Size (adult unisex)
*
Please select all that apply.
S
M
L
XL
2XL
3XL
Parent/Guardian Info
Parent/Guardian Name
*
Phone
*
Email
*
This address will receive a confirmation email
Address
*
--
AA
AB
AE
AK
AL
AP
AR
AS
AZ
BC
CA
CO
CT
DC
DE
FL
FM
GA
GU
HI
IA
ID
IL
IN
KS
KY
LA
MA
MB
MD
ME
MH
MI
MN
MO
MP
MS
MT
NB
NC
ND
NE
NH
NJ
NL
NM
NS
NT
NU
NV
NY
OH
OK
ON
OR
PA
PE
PR
PW
QC
RI
SC
SD
SK
TN
TX
UT
VA
VI
VT
WA
WI
WV
WY
YT
Emergency Contact Info
Emergency Contact Name
*
Emergency Contact Phone
*
Emergency Contact Email
*
COST
Total camp cost is $375/student.
$100
non-refundable
deposit holds your spot.
Payment
Deposit ($100)
Full Payment ($375)
Deposit ($100)
Full Payment ($375)
Amount
Credit/Debit Card Number
Expiration Date/CVC
Name on Card
Card Billing Address
AA
AB
AE
AK
AL
AP
AR
AS
AZ
BC
CA
CO
CT
DC
DE
FL
FM
GA
GU
HI
IA
ID
IL
IN
KS
KY
LA
MA
MB
MD
ME
MH
MI
MN
MO
MP
MS
MT
NB
NC
ND
NE
NH
NJ
NL
NM
NS
NT
NU
NV
NY
OH
OK
ON
OR
PA
PE
PR
PW
QC
RI
SC
SD
SK
TN
TX
UT
VA
VI
VT
WA
WI
WV
WY
YT
Submit
Description
Camp 220 Student Summer Camp
July 17-21, 2023
$375/student- $100 non-refundable deposit
Completed 6th to 12th (as of summer 2023)
×
Please Fix the Following